Angiogenesis and placental growth in normal and compromised pregnancies

Research on the subject of pre-eclampsia has revolved around placental growth and angiogenesis, as both are central to the aetiology of the disease. Vascular angiogenic growth factor (VEGF) is elevated in pre-eclampsia and correlates with the severity of disease. Its actions in vitro mimic the actions of plasma from women with pre-eclampsia. This chapter examines the available evidence that implicates VEGF in the maternal systemic effects seen in pre-eclampsia, and discusses how an understanding of this growth factor could lead to diagnostic and therapeutic options. Oxygenation status is the unifying concept that surrounds the discussion of placental growth and angiogenesis. The concept that ‘hypoxia’ is too simplistic a notion to describe pre-eclampsia is discussed. Maldevelopment of the angiogenic process can be assessed by Doppler ultrasound. The future may see a role for magnetic resonance imaging in the identification of poorly perfused placenta.